Cedar Court

Cedar Court is a care home for people with learning disabilities and/or autism. The service was providing personal care to 12 people at the time of the inspection. The service can support up to 13 people. The ages of people living at the service ranged from 19 to 53 years old.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. The provider had re-designed the layout of the service to ensure it complies. The property which comprised of two semi-detached houses were being run as two separate units. The next part of the development was to add an additional kitchen. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

Cedar Court placed people at the heart of the service. People benefited from staff and management who were passionate about supporting them to live their best possible life. Staff knew people really well and understood and respected how they wished to be supported. People told us they enjoyed living at the service and we saw many examples where the actions of the service had resulted in an improved quality of life for people. Relatives told us, “I can’t imagine any service could do better” and “I find they are very helpful and supportive in seeing that he has the best care possible.”

Each person was seen as an individual by staff, who knew their wishes and aspirations. Staff worked with people to put together a very detailed care plan and achieved their desired outcomes. Together, they identified suitable activities, education and work. Staff were highly responsive in identifying people's needs and ensured they were supported in the best way possible.

People benefited from compassionate support provided by a kind, committed and caring staff team. People told us, "They’re good people, they look after me” and “I'm very happy.” We observed one person say to staff, “I love you guys.” People were treated equally and with respect. Staff recognised the importance of family and friends and helped people maintain these important contacts.

People's risks were understood and managed well. People were protected from discrimination and abuse because staff understood how to safeguard them. Staff had the skills and knowledge to support people safely and effectively. People were supported to maintain good health and had access to external healthcare support. Where necessary, staff supported people to attend medical and hospital appointments to ensure they felt comfortable with what was happening.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. For example, one person had moved on to more independent living and another person was soon due to move on.

Since the previous inspection the directors and registered managers had continued to develop and improve the service. People and staff benefited from strong leadership. The ethos of the service was understood and shared as the directors, registered managers and compliance manager all worked alongside staff as support workers. There was a strong commitment to valuing people as individuals and supporting them to meet their full potential. Robust quality assurance systems ensured continuous improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 9 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 24 July 2017 and was unannounced.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection of the service in May 2016 the service was rated as ‘requires improvement’. On this inspection we saw improvements had been made. For example on the last inspection the governance systems at the service were not robust, and quality assurance systems were not well developed. On this inspection we found improved systems had been put in place to assess, monitor and improve the quality and safety of the services provided. This included more robust auditing systems and regular assessments and reports being undertaken to highlight any concerns, trends or areas needing attention. Feedback was being obtained from people living at the service, relatives, staff and healthcare professionals in order to improve the service, and improvements had been made as a result.

On the last inspection we had identified concerns over the support planning systems in use. On this inspection we saw improvements had been made. People’s care plans contained information about any health concerns and support needed, for example with managing long term health conditions. Positive support plans and communication strategies helped identify potential signs and causes of anxiety or distress and how to support the person to reduce this. Some plans to do this had been drawn up with the support of specialist professionals, and covered any risks from or to the person.

People were protected from the risk of abuse as staff understood the signs of abuse and how to report any concerns. Staff spoke very positively of people, and were enthusiastic about supporting people at the service, including celebrating any advances people made towards greater independence. People’s rights were respected, and staff had received training and had a clear understanding of the Mental Capacity Act 2005 in practice. Where people lacked capacity to make an informed decision, staff acted in their best interests, and with significant decisions had involved other parties such as relatives or medical teams to assist with decision making. Appropriate applications had been made to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS), and systems were in place to manage any concerns or complaints.

There were enough staff employed by the service to meet people’s needs. Many people had defined staffing levels, such as one to one staffing, or more in specific circumstances. The service had access to a flexible group of bank staff who were familiar with people, so they were always supported by someone who knew them well and understood their needs. This helped to reduce people’s anxiety. Since the last inspection improvements had been made to the staff recruitment process, with improved risk assessment processes. This helped to ensure people were supported by suitable staff.

Staff had the skills and support they needed to carry out their role effectively. There was a programme of training in place, and staff told us they were well supported both by their team colleagues and the service’s management. Staff training updates were booked and new staff were completing the care certificate, which is a set of standards that should be covered as a part of induction training for staff new to care.

People received their medicines safely as prescribed. Staff had received training in medicines management, systems were audited and actions taken to reduce any risk of errors.

People’s health was promoted because they were supported to have enough to eat and drink. Some people were involved in shopping for and preparing their own meals, and the service aimed to offer advice on healthy eating and choices. Where one person needed additional support we saw this was given with gentleness and time to enjoy their food.

Accommodation had been adapted to meet individual people’s needs and was subject to an ongoing programme of refurbishment and improvement. Cedar Court comprised two semi-detached properties, linked internally. One side of the property provided flatlets for people, while the other provided more traditional residential rooms with shared spaces, such as the kitchen. Accommodation had been adapted to meet individual’s needs and wishes. For example one person was involved in making decisions about a refurbishment of their flat.

People were treated with dignity and respect. They were encouraged to participate in activities of their choice and on the day of the inspection we saw the service was busy and active, with people going out with relatives, shopping, visiting a local carnival, going out for coffee to a local beauty spot, playing computer games and undertaking service tasks such as laundry. People’s independence was encouraged and people were supported to develop this at their own pace, with small steps, based on their own “Pathway to independence” documents.

There was a clear philosophy for the service which was well understood by staff. The registered manager and directors were well respected and demonstrated the values in practice. Staff understood their roles and were positive about the experience of working at the service. Systems were in place to ensure effective communication.

Records were well maintained and kept securely. The service had notified the CQC of incidents at the service as required by law.

The home had a manager in post, but they were not yet registered with us. They are referred to throughout the report as the manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

This inspection took place on 10 May 2016, and was unannounced. During the inspection we found some positive practice in place, and some areas where the home needed to improve.

Risks to people had not all been reviewed or updated since the person had moved to Cedar Court. Staff had positive approaches to risk taking, but some of the information in people’s files was from previous places where people lived, which meant it may not be accurate or up to date. People had been encouraged to be involved in decisions which affected them, and in writing their care plans. However not all the care plans were up to date or reflective of people’s care at the time of the inspection.

Staff training and support needs had not always been identified or met. Staff spoke passionately about their work and the people they supported, and we saw evidence of positive, caring and supportive relationships. But staff did not all have the up to date knowledge or skills needed to support people with their needs. Gaps in care planning and records meant this presented a higher level of risk as staff could not use these with confidence to support people. We have made a recommendation in relation to staff training and support systems.

People were protected from the risk of abuse as staff understood the signs of abuse and how to report concerns. People benefited from sufficient staff to meet their needs, and staffing levels were increased to meet their wishes regarding activity. However systems were not in place to manage any risks associated with the staff recruitment process. The staff team were clear about and were encouraged to work within the ethos and philosophy of the home. The home had a strong, visible person centred culture and was good at helping people who used the home to express their views. People were encouraged and supported to engage with the local community. Where people had raised concerns these were managed well.

People received their medicines as prescribed. The systems in place for the management of medicines protected people who lived at the home; however we identified some concerns that prescriptions were not always clearly written. The manager agreed to clarify these with the prescriber to ensure they were being given at safe intervals.

Accommodation was personalised and had been adapted to suit individual people’s needs. Some people had their own flats which they were able to personalise. Other people had more traditional residential care accommodation. Movement between the two semi-detached houses, which might be necessary to enable people to access the central kitchen was managed through the use of electronic key fobs.

People had access to the healthcare services they needed, including a staff having a clear understanding of when emergency care was needed for one person. The home had thought about people's needs and relatives were being involved in making best interest decisions where people needed support in making decisions. Appropriate applications had been made under the Deprivation of Liberty Safeguards to help protect people’s rights and safety.

There were some systems and audits in place to assess and monitor the quality of the home, but these were not all robust. The quality assurance system had not been fully completed, and some records were not comprehensive enough or well maintained. Some records were not well maintained, and systems for the management of risks were not always ensuring people’s safety. For example, the laundry systems at the home did not provide a safe system for the potential control of infection. We have made a recommendation in relation to the systems for control of infection at the home.

We identified a breach of regulations during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We found that 10 people lived at Innisfree. We spoke with four of those people. They told us they enjoyed living there and were 'well looked after'. One person told us 'There are always enough staff to take care of me'. Another said 'Staff know what they're doing and are very pleasant.' A visiting relative told us 'The staff are competent and can move people safely'.

We saw evidence that a great deal of relevant training had been scheduled and delivered since our last inspection. We found that the vast majority of staff had completed up to date training. This included training which would support the safe moving and handling of people who required assistance to mobilise.

Staff told us that they had received training in key areas since our last inspection and that they had received regular supervision. We found that staff meetings had taken place. All of the staff we spoke with told us that they felt supported.

We found that there were sufficient numbers of staff to provide care safely to everyone who lived at the home.